A total of 6.8 million injuries and illnesses were reported in private industry workers during 1994. Return-to-work (RTW) programs promote optimal recovery in injured workers; the rationale for RTW programs is based on evidence that proactive management of occupational injuries can significantly reduce the magnitude and duration of work-related disability. However this evidence comes almost exclusively from large companies (e.g., Boeing) in metropolitan areas. The objective of the proposed project is to systematically evaluate the feasibility of delivering nurse-coordinated RTW services in rural settings. Rather than transfer a centralized system to the rural setting, the RTW intervention will capitalize on the familiarity and expertise of local community nurses and physicians to direct and provide interventions in their own communities. The project will be conducted in three phases. Phase 1 includes a secondary analysis of data from three Oregon studies (n=927 workers) directed toward rural workers. These data, combined with clinical findings addressing low-back injuries, form the empirical foundation for the RTW intervention. Phase 2 includes a feasibility study delivered in two sites (Missoula, Montana and LaGrande, Oregon), 60 workers will be randomly assigned to either the RTW intervention or standard care. The intervention is comprised of four home/worksite visits to injured workers focusing on targeted areas of disability reduction. Phase 3 focuses on the development of an empirically-based risk reduction model for rural workers employed in small companies. Within this context, specific aims include: 1) Finalize components of the RTW intervention using data from the Oregon studies, 2) Train local nurses to provide the intervention, 3) Conduct a feasibility study testing the intervention in two communities, 4) Compare clinical and employment outcomes between the experimental and control groups, 5) Evaluate the feasibility of a multi-site clinical trial in rural communities, and 6) Develop an empirically-based model of risk reduction for injured workers in rural communities.